External beam radiation therapy for prostate cancer clinically confined to the gland

The outcome of treatment of prostate cancer localized to the gland is similar whether treated with radical surgery or external beam radiation therapy. This is best illustrated in four separate series of patients with Stages A and B cancer with negative lymph node dissections treated with radiation. These data are compared with the Uro-Oncology Group trial of radical prostatectomy versus external beam radiation therapy in which the radiation therapy arm behaved like Stage C cancer. Comparison of fifteen-year results for patients with B1 nodules of unknown lymph node status (Gibbons, Jewett and Bagshaw) show survival of 51 to 55 percent at fifteen years despite the fact that the radiation therapy group treated all states of health and histology. The national averages for treatment of all histology and states of health for Stage B patients is 16 percent below age-group expected survival at ten years. Patients with Stage A cancer treated with external beam radiation exactly match their age-group expected survival. Similar national averages for ten-year survival for 313 T1 (early Stage B) patients is within 11 percent of expected survival at ten years even though 30 patients had poorly differentiated tumors. The real question in early prostate cancer is a comparison of complications of treatment. Comparison of the U.S. national averages for radiation therapy are reviewed along with the major surgical series.